Leiomiosarcoma de vena cava inferior, reconstrucción mediante interposición de prótesis y anticoagulación

Alison Guillén; Nicolás Tarigo; Mariana Zeoli; Federico Cabo; Gustavo Andreoli; Roberto Valiñas

doi:10.29193/RMU.39.2.11

Authors

Alison Guillén Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica, Residente
Nicolás Tarigo Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica F, Profesor Adjunto
Mariana Zeoli Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica F, Asistente
Federico Cabo Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Catedra de Imagenología, Asistente
Gustavo Andreoli Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica F, Profesor Agregado
Roberto Valiñas Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Quirúrgica F, Profesor Director

DOI:

https://doi.org/10.29193/RMU.39.2.11

Keywords:

LEIOMYOSARCOMA, PROSTHESES AND IMPLANTS, INFERIOR VENA CAVA

Abstract

Primary leiomyosarcoma of the vena cava is a very rare neoplasm that originates from the smooth muscle cells of the tunica media. It represents 2% of all the leiomyosarcomas and 60% of the vena cava tumors. We report a case of 64-year-old patient consulting for a lower right back pain. The computed tomography shows a large retroperitoneal mass which encompasses the inferior vena cava and involves of right kidney. The surgical treatment of tumor resection is performed with right nephrectomy and interposition of Dacron prosthesis. The anatomopathological study shows a high-grade leiomyosarcoma, not compromising the renal capsule, with resection free. Radical resection with negative margins currently offers the best survival rate. Anticoagulation treatment for patients with prosthesis placement is still under discussion.

References

1) Lee HM, Jeong DS, Park PW, Kim WS, Sung K, Lee YT. Surgical treatment for an invasive leiomyosarcoma of the inferior vena cava. Korean J Thorac Cardiovasc Surg 2013;46(5):373-6. doi: 10.5090/kjtcs.2013.46.5.373.
2) Moreno-H A, Fernández-V L, López-B J, Pérez-D María. Tratamiento multidisciplinar del leimiosarcoma de vena cava Inferior Multidisciplinary treatment of leiomyosarcoma of inferior cava. Rev Cir (Mex) 2020; 72(1):72-5. doi: 10.35687/s2452-45492020001442.
3) García M, Messa O, Ríos D, López H, Canedo J. Leiomiosarcoma de la vena cava inferior: reporte de un caso y revisión de la literatura. Rev Colomb Cancerol 2014; 18(1):41-5. doi: 10.1016/S0123-9015(14)70223-9.
4) Guerrero MA, Cross CA, Lin PH, Keane TE, Lumsden AB. Inferior vena cava reconstruction using fresh inferior vena cava allograft following caval resection for leiomyosarcoma: midterm results. J Vasc Surg 2007; 46(1):140-3. doi:10.1016/j.jvs.2007.02.043.
5) Spinelli A, Schumacher G, Benckert C, Sauer IM, Schmeding M, Glanemann M, et al. Surgical treatment of a leiomyosarcoma of the inferior vena cava involving the hepatic and renal veins confluences: technical aspects. Eur J Surg Oncol 2008; 34(7):831-5. doi: 10.1016/j.ejso.2007.01.015.
6) Saikia J, Rastogi S, Barwad A, Dhamija E, Pandey R, Bhoriwal S, et al. A systematic review of the current management approaches in leiomyosarcoma of inferior vena cava-Results from analysis of 118 cases. Asian Cardiovasc Thorac Ann 2022; 30(3):349-63. doi: 10.1177/02184923211049911.
7) Pérez-de-Villar JM, Arjona-Sanchez A, Rufián-Andujar B, Valenzuela-Molina F, Sánchez-Hidalgo JM, Rodriguez-Ortiz L, et al. Surgical treatment of vena cava leiomyosarcomas: series of cases in a referral center and literature review. Cir Esp (Engl Ed) 2022; 100(8):481-7. doi: 10.1016/j.cireng.2022.05.020.
8) Quiñones-Baldrich WJ. Prosthetic replacement of the inferior vena cava. Ann Vasc Surg. 1999; 13(4):449-56. doi: 10.1007/s100169900282.
9) Manzanet G, Morón R, Suelves C, Calderón R, Corell R, Castell L, et al. Sustitución protésica de la vena cava inferior. Controversias actuales. Cir Esp 2005; 77(3): 170-2. doi: 10.1016/S0009-739X(05)70831-9.
10) López-Ruiz JA, Tallón-Aguilar L, Marenco-de la Cuadra B, López-Pérez J, Oliva-Mompeán F, Padillo-Ruiz J. Leiomyosarcoma of the inferior vena cava. Case report and literature review. Cir Cir (Engl Ed). 2017; 85(4): 361-5. doi: 10.1016/j.circen.2017.07.003.
11) Kieffer E, Alaoui M, Piette JC, Cacoub P, Chiche L. Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg 2006; 244(2):289-5. doi: 10.1097/01.sla.0000229964.71743.db.